A major new international study provides compelling prospective evidence that cardiovascular magnetic resonance imaging (CMR) should play a central role in the evaluation and long-term management of patients with hypertrophic cardiomyopathy (HCM).
The study team, led by the University of Virginia’s Dr Christopher Kramer MD, MSCMR, Stefan Neubauer MD, MSCMR included Leicester’s Professor of Cardiac Imaging, Gerry McCann.
Hypertrophic cardiomyopathy (HCM) is a genetic heart condition in which the heart muscle becomes abnormally thick (hypertrophied). This thickening can make it harder for the heart to pump blood effectively and in some patients it can also block blood flow out of the heart.
The NHLBI-funded Hypertrophic Cardiomyopathy Registry (HCMR) followed nearly 2,700 patients across 44 specialist centres in Europe and North America over almost seven years.
Key findings published in JAMA in May 2026.
Importantly, the study demonstrated that several CMR-derived markers were among the strongest predictors of adverse clinical outcomes, including:
• Late gadolinium enhancement (LGE) burden
• Left ventricular mass index
• Left end-systolic volume
• History of heart failure
• log(NT-proBNP)
These imaging markers, together with log(NT-proBNP) and heart failure history, significantly improved prediction of both major composite outcomes and sudden cardiac death/ventricular arrhythmic events.
One of the most clinically relevant findings was the strong prognostic value of myocardial scar quantified by LGE. An LGE burden ≥9% of LV mass was associated with a marked increase in adverse events, supporting prior observations that fibrosis burden is a key determinant of arrhythmic risk in HCM.
The study also reinforces the importance of moving beyond simple wall thickness measurements toward more comprehensive three-dimensional assessments of hypertrophy and ventricular remodelling using CMR.
Professor of Cardiac Imaging at the University of Leicester, and Cardiovascular Theme Lead for the NIHR BRC Leicester, Gerry McCann, played a key role in advancing the study’s imaging insights. His work continues to drive innovation in CMR, helping integrate advanced imaging into routine clinical pathways.
Lead author on the study, Dr Kramer said: “This study identifies MRI markers and a blood test that identify patients with this disease who are at higher risk of death from heart failure, stroke, or sudden death from fast heart rhythms. Patients with HCM who are identified early can then receive therapies that save lives.”
This study strengthens the case for incorporating CMR and biomarkers such as NT-proBNP into standard HCM assessment, enabling earlier identification of high-risk patients and more informed, life-saving clinical decisions.
For the full paper please visit: https://jamanetwork.com/journals/jama/article-abstract/2848800
For more on the work of our Cardiovascular theme click here.